You may be asked to provide procedure (CPT) codes, the following can be provided to determine if the codes are valid to be billed and if pre-certification is required:
45378 45380 45385
If diagnosis codes (ICD-10) codes are requested, provide any of the following that apply to you:
Z12.11 (screening colonoscopy) Z86.010 (personal history of colon polyps)
Z83.71 (family history of colon polyps) Z80.0 (family history of colon and/or rectal cancer)
1) Tell the representative that you are calling regarding physician service benefits for a screening colonoscopy.
Procedure code (CPT): 45378 Diagnosis code (ICD-10): Z12.11 Cost of procedure: $1885.00
Most insurance companies will cover a screening colonoscopy for age 45 and up, but some employer sponsored plans may opt to not cover screening colonoscopies until age 50 and up. Be sure to ask the representative if there are any age restrictions.
The CPT code and cost above is only an estimate for a screening/routine colonoscopy. If a polyp or another condition is found then your procedure and diagnosis codes will change and may result in your colonoscopy becoming diagnostic/medical.
Procedure code (CPT): 45380 Diagnosis code (ICD-10): D12.0-D12.9* Cost of procedure: $2300.00